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Understanding
Child and Adolescent Temper, Anger and Behavior Disorders — Questions & Answers
How can I tell if my kid has a psychiatric
problem or is just going through a phase?
When a youngster temporarily acts up, as when exhausted,
parents can see the problem and respond. They remember the
real child
behind the chaos of the moment. But a behavioral disorder is
not temporary and does not pass after a good night’s sleep.
When warning signs such as aggressive outbursts, trouble keeping
friends, patterns of irritability, low self-esteem, and lack
of concentration persist, parents should seek professional
help.
What are some of the most common adolescent
behavior problems?
Three common forms of behavior disorders include Attention-deficit
Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder
(ODD) and Conduct Disorder (CD). ADHD children have a serious
problem paying attention and this disability interferes with
their lives, especially at school. ODD refers to the youngster
who exhibits negative, hostile and defiant behavior, without
seriously violating the rights of others. A more serious disruptive
disorder is a Conduct Disorder where the adolescent exhibits
behavior patterns which violate the rights of others as well
as the societal norms appropriate for his age.
What behavioral treatments and family therapies
are most effective?
Treatment programs should include efforts to help the home
environment. Behavior disorders disrupt the household and the
family needs some guidance in regaining its balance. Family
therapy is a way of opening up parent-child communications
and changing patterns that reinforce negative behaviors. Individual
therapy can be helpful for the youngster’s difficulties
with impulsivity, low self-esteem and poor peer relationships.
Disruptive disordered children need to learn how to think before
they act and recognize the consequences of their behavior.
Behavioral modification is often used to help modify the negative
behaviors these youngsters display. It promotes desirable behavior
by immediately reinforcing the proper action.
How does oppositional defiant disorder
differ from conduct disorder?
Conduct Disorder is a more serious disruptive disorder than
Oppositional Defiant Disorder. CD youngsters violate the rights
of others as well as the societal norms appropriate for their
age. A child with CD may repeatedly engage in vandalism, theft,
and fighting. ODD children often lose their temper, refuse
adult requests, are easily annoyed by others and are often
spiteful and vindictive.
Do children continue to suffer from ADHD
all of their lives?
Disruptive disorders arise from biological problems, which
may recede in time but often continue. ADHD adults fit roughly
into three categories. One group, comprised of 30 to 40 percent
of the whole, has outgrown the problem. The largest group,
approximately 40 to 50 percent, continues to have symptoms
of impulsive behavior and/or restlessness and/or inattention,
but despite significant difficulties they do not have severe
psychiatric problems and are able to lead self-sufficient lives.
The third group, a minority of about one in ten, are severely
dysfunctional. As adults they may even require hospitalization,
or a few may end up in jail. This minority could be made even
smaller if treatment and help were more readily available and
were followed more rigorously.
Can anything be done to prevent temper,
anger & behavior disorders?
The obvious first step in preventing the development of conduct
disorder is to treat whatever has put a child at risk. ADHD,
for example, may put the child at risk for a conduct disorder;
controlling the ADHD is an important step in preventing the
rise of antisocial complications. The key to preventing the
development of a conduct disorder lies in helping the children
get control over their own behavior and in teaching families
how to help their child become more responsible and social.
Diagnostic Criteria
Attention-deficit Hyperactivity Disorder
*Note Consider a criterion met only if the behavior is considerably
more frequent then that of most people of the same mental
age.
A. A disturbance of at least six months during which
at least eight of the following are present:
- Often fidgets with hands or feet
or squirms in seat (in adolescents, may be limited
to subjective feelings of restlessness)
- Has difficulty
remaining seated when required to do so
- Is easily distracted
by extraneous stimuli
- Has difficulty awaiting turn in games
or group situations
- Often blurts out answers to questions
before they have been completed
- Has difficulty
following through on instructions from others (not due
to oppositional
behavior or failure
of comprehension), e.g., fails to finish chores
- Has difficulty sustaining attention in tasks or play
activities
- Often shifts from one uncompleted activity
to another
- Has difficulty playing quietly
- Often talks excessively
- Often interrupts or intrudes
on others, e.g., butts into other children’s games
- Often does not seem to listen to what is being said to
him or her
- Often loses things necessary for tasks
or activities at school or at home (e.g.,
toys, pencils,
books, assignments)
- Often engages in physically dangerous
activities without considering possible consequences
(not for
the purpose of thrill-seeking), e.g., runs
into street without looking
B. Onset before the age of seven.
C. Does not meet the criteria for a Pervasive
Developmental Disorder.
Diagnostic Criteria
Oppositional
Defiant Disorder
*Note: Consider a criterion met only if the behavior is
considerably more frequent than that of most people of the
same mental age.
A. A disturbance of at least six months
during which at least five of the following are present:
- Often
loses temper
- Often argues with adults
- Often actively defies or refuses
adult requests or rules, e.g., refuses to do chores
at home
- Often deliberately does things that
annoy other people, e.g., grabs for other
children’s
hats
- Often blames others for his or her
mistakes
- Is often touchy or easily annoyed
by others
- Is often angry and resentful
- Is often spiteful or vindictive
- Often swears or uses
obscene language
B. Does not meet the criteria for Conduct
Disorder, and does not occur exclusively during the course
of
a psychotic disorder, Dysthymia, or a Major Depressive,
Hypomanic or Manic episode.
Diagnostic Criteria
Conduct Disorder
*Note: Consider a criterion met
only if the behavior is considerably more frequent than that
of most people of the same mental age.
A. A disturbance of conduct lasting
at least six months, during which at least three of the following
have
been present:
- Has stolen without
confrontation of a victim on more than one occasion (including
forgery)
- Has run away from home overnight at least
twice while living in parental or parental surrogate
home (or once without returning)
- Often lies (other
than to avoid physical or sexual abuse)
- Has deliberately
engaged in fire-setting
- Is often truant from school (for
older person, absent from work)
- Has broken into someone
else’s
house, building, or car
- Has deliberately destroyed
others’ property
(other than by fire-setting)
- Has been physically
cruel to animals
- Has forced someone into sexual activity
with him/her
- Has used a weapon in more than
one fight
- Often initiates physical fights
- Has stolen with confrontation
of a victim (e.g., mugging, purse-snatching,
extortion,
armed
robbery)
- Has been physically cruel
to people
B. If 18 or older, does not meet criteria
for Antisocial Personality Disorder.
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